Provider Demographics
NPI:1275178048
Name:HEYDEMAN, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:HEYDEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19018-2305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:467 CREAMERY WAY
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2508
Practice Address - Country:US
Practice Address - Phone:610-363-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136610101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor